[Question #9265] Occupational Risk

34 months ago

Hello! I can’t believe I’m asking this but bc of my own situation- this situation has reared its head.

In January 2019 my child had a surgery. One of his monitoring anesthesia needles(not hollow bore) was coming out. A nurse went to put it back in and stuck herself. The nurse anesthetist took the needle and placed it back in my child’s hand.

The nurse for protocol went for a 4th gen test which was negative and within days a PCR which showed undetectable. I didn’t like the use of that word and questioned why not say not detected. To them it was six in one half dozen in the other. To them it meant negative. No viral load detected and no antibodies nor antigen detected.

This nurse has zero risk factors. Still works at the hospital in the surgical wing.

My issues are 1. I accepted this at the time bc my knowledge was not as anxiety ridden as it is now. I posed the question to them today that what if theoretically she was infected that morning of the surgery- her tests were not conclusive! 2. None of the doctors at that time including a ID recommended PEP for my child. 3. The needle unknown if it was wiped but let’s say it wasn’t was not entering a vein nor deep tissue. It was a monitoring needle and I suppose only a drop of blood if that would have been on it. I’m not even sure if it fell on the floor.

Here we are four years later. My child recently felt a numbness in his hands (dropping his phone out of his hands probably after hours of holding it). And my anxiety has the best of me.

Should I put this out of my head? I know the chance of her acquiring HIV that very day is nil if not impossible. I also know there have been no needle stick injuries since 1999 (not sure if there has been but from what I’m finding none). I am wracked with guilt I should have put him on PEP but my knowledge was so limited.

Further his needle being non hollow bore and a monitoring needle I assume it did not go too far into his skin. (I’m not a professional so I don’t know how far they go int

34 months ago

And how much blood would even be on it to pose a risk. Thank you.

H. Hunter Handsfield, MD

34 months ago

Welcome back to the forum, but I'm sorry you found it necessary.

It's very surprising to hear a nurse stuck herself then used the same needle for your child's IV line. However, you give solid evidence the nurse did not have HIV and there is no risk your child has it. I don't understand your concern or uncertainty about the terminology for negative test results. There is no difference between "negative", "not detected", and "undetecatble", and none is intended by labs, doctors, or anyone else who uses these terms. The nusre's test results conclusively prove your child could not have been infected by contact with her blood. You had accurate advice at the time: your child did not need PEP and your guilt at not requesting it is unwarranted.

Further, there is nothing in your child's symtoms that suggests HIV. And you the go on to give additional reasons why there was no chance he was exposed or infected. I agree with them.

As for how much blood it takes for such an exposure to transmit HIV, nobody really knows -- except that visible blood in substantial amount was involved in most or all known HIV infections acquired by injury with sharp instruments. But more important, the level of risk at the time of exposure doesn't matter anyway. You have proof your son was not exposed. You could have told me he received a blood transfusion from the nurse, and I would continue to advise there was no risk.

You're seriously overthinking all this. My advice is to move on without further worry.

I hope these comments are helpful, but I have to say our thought processes on all this are not entirely rational. I am worried you are suffering from some rather serious unresolved stress or other emotional issues that are affecting your perspectives on HIV risks. You gave plenty of potential reasons in your previous thread. If you continue to have these fears about your son and HIV (or maybe still unresolved anxieties about your own HIV risks?), I would suggest professional counseling. I suggest it from compassion, not criticism. But for now I hope these comments provide the reassurance you seek.

HHH, MD

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34 months ago

Thank you for your quick response. Just to clarify the nurse that stuck herself did not put the monitoring needle back in; the nurse anesthetist did.

My issue was only the fact that her tests were not done within the recommended time periods for detection. That was truly my only concern. While the 4th gen picked was negative and the PCR zero viral load; they were done almost contemporaneous with the event to maybe a few days. That was my only fear; if she had a recent infection this was not enough for early detection.

I have looked into taking to someone about OCD intrusive thoughts. This being one of them. Thank you.

34 months ago

Oh and perhaps I was not clear (typing always loses things), it was a monitoring needle for anesthesia not an IV.

H. Hunter Handsfield, MD

34 months ago

Thanks for clarifying the needle use business etc. It makes more sense than my initial assumption.

You misunderstand the meaning of the nurse's test results. (And maybe so did some of the doctors involved at the time?) The timing of her tests doesn't matter. Regardless of when someone was exposed or infected, and regardless of how long they have had HIV, an undetectable (negative, "not detected") RNA test on blood -- also called a "viral load" test -- means that person cannot infect anyone else. It's the entire basis behind the national "U=U" ad campaign for people at risk: "Undetectable = Untransmittable", meaning that infected people taking anti-HIV drugs, with resulting negative RNA test result, are free of any risk of transmitting HIV. The same test is part of the protocol that has resulted in no HIV transmissions by blood transfusion in the US for the past 20 years or so: negative RNA testing is a requirement on all blood to be transfused.

In other words, if you were exposed today and say 3 days from now your RNA test were negative, then even if you had acquired HIV, you could not yet transmit it to anyone else, via your blood, sex, or any other route.

Got it?

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34 months ago

Yes. That actually clarifies it all.

First I truly thought (wrongfully) U=U was only for those on antiretrovirals, not those with very recent infection.

Second I should stay off the internet as I was also under the impression U=U only applies to sex and sexual fluids and not blood.

While I see the CDC states undetectable greatly reduces other modes of transmission, but they don’t know how much- I assume in the real world and (not the super conservative internet), this U=U has applied generally across the board (i.e. no reported cases of blood on a needle transmitting when someone is U=U)

You see this in real life and your expertise is more comforting than a bunch of websites. :)

H. Hunter Handsfield, MD

34 months ago

It is true that the U=U campaign is aimed exclusively at sexual exposures; and most ads are from drug companies, so the emphasis is on ARVs. But the evidence is that negative RNA testing predicts non-transmissibility by blood as well, mostly from the blood transfusion data -- even if the data are indirect, hence CDC's "don't know how much" statement. (CDC traditionally is very conservative in how they interpret and set policy based on scientific data. But in a country with millions of blood donations annually, at least a few donors must have recently acquired HIV, yet no known transfusion acquired cases for >20 yr).)

That completes two follow-up exchanges and so ends this thread. I hope the two discussions have settled all your concerns about HIV. You can truly believe you and your son do not have it, and there should be no worries about HIV going forward. As implied above, both this and your previous question provide plenty of reason to worry about some unresolved issues you may have that might warrant professional attention. I definitely suggest it from compassion, not criticism. Very best wishes to you.---